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This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm.
All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the three months from 1st March to 31st May 2020. These data were compared with presentations in the same months in the three years preceding (2017-2019). Data were obtained from the anonymised service database.
This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a four-year period were examined, there was a significantly higher lethality of attempt (p<0.001), and significant differences in diagnosis (p=0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p=0.036). There were also significant differences in the underlying psychiatric diagnoses(p=0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period.
COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of the restrictions and changes due to Covid-19, especially with respect to self-harm.
We describe the adaptation of services to allow flexible and practical responses to the COVID-19 public health crisis by four Consultation-Liaison psychiatry (CLP) services; Galway University Hospital, Beaumont Hospital, University Hospital Waterford and St Vincent’s University Hospital CLP Services. This article also illustrates close collaboration with community adult mental health services and emergency department colleagues to implement effective community diversion pathways and develop safe effective patient assessment pathways within the emergency departments. It highlights the high levels of activity within each of the CLP services, while also signposting that many of the rapidly implemented changes to our practice may herald improvements to mental health patient care delivery in the post COVID-19 world, if our psychiatry services receive appropriate resources.
Is darker skin pigmentation associated with less favorable social and political outcomes in Latin America? We leverage data from 18 Latin American countries across multiple survey waves to demonstrate the robust and potent negative relationship between the darkness of skin tone and socio-economic status. Then we examine the relationship between skin color and attitudes toward the political system. In spite of our substantial sample size, we find little support for the expectation that respondents with darker skin are less favorably disposed toward the political system—indeed, on balance, our findings run counter to this expectation. Our findings suggest that the socio-economic “pigmentocracy” that pervades the region does not necessarily translate into pronounced differences in attitudes about the political system. This finding casts some doubt on the expectation that social inequalities are likely to destabilize governments or undermine their legitimacy.
While feed efficiency (FE) is a trait of great economic importance to the pig industry, the influence of the intestinal microbiome in determining FE is not well understood. The objective of this experiment was to determine the relative influence of FE and farm of birth on the pig colonic microbiome. Animals divergent in residual feed intake (RFI) were sourced from two geographically distinct locations (farms A + B) in Ireland. The 8 most efficient (low RFI (LRFI)) and 8 least efficient (high RFI, (HRFI)) pigs from farm A and 12 LRFI and 12 HRFI pigs from farm B were sacrificed. Colonic digesta was collected for microbial analysis using 16S ribosomal RNA gene sequencing and also for volatile fatty acid analysis. The α-diversity differed between the farms in this study, with pigs from farm A having greater diversity based on Shannon and InvSimpson measures compared to pigs from farm B (P < 0.05), with no difference identified in either Chao1 or observed measures of diversity (P > 0.05). In the analysis of β-diversity, pigs clustered based on farm of birth rather than RFI. Variation in the management of piglets, weight of the piglets, season of the year, sanitary status and dam dietary influence could potentially be causative factors in this large variation between farms. However, despite significant variation in the microbial profile between farms, consistent taxonomic differences were identified between RFI groups. Within the phylum Bacteroidetes, the LRFI pigs had increased abundance of BS11 (P < 0.05) and a tendency toward increased Bacteroidaceae (P < 0.10) relative to the HRFI group. At genus level, the LRFI pigs had increased abundance of Colinsella (P < 0.05), a tendency toward increased Bacteroides and CF231 (P < 0.10). At species level, Ruminococcus flavefaciens had increased abundance in the LRFI compared to the HRFI animals. In conclusion, while farm of birth has a substantial influence on microbial diversity in the pig colon, a microbial signature indicative of FE status was apparent.
Nerve transfer surgery for patients with nerve and spinal cord injuries can result in dramatic functional improvements. As a result, interdisciplinary complex nerve injury programs (CNIPs) have been established in many Canadian centers, providing electrodiagnostic and surgical consultations in a single encounter. We sought to determine which allied health care services are included in Canadian CNIPs, at the 3rd Annual Canadian Peripheral Nerve Symposium. Twenty CNIPs responded to a brief survey and reported access as follows: occupational therapy = 60%, physiotherapy = 40%, social work = 20%, and mental health = 10%. Access to allied health services is variable in CNIPs across Canada, possibly resulting in heterogeneity in patient care.
Invasive predators have decimated island biodiversity worldwide. Rats (Rattus spp.) are perhaps the greatest conservation threat to island fauna. The ground nesting Palau Micronesian Scrubfowl Megapodius laperouse senex (Megapodiidae) inhabits many of the islands of Palau’s Rock Island Southern Lagoon Conservation Area (RISL) in the western Pacific. These islands are also heavily visited by tourists and support populations of introduced rats, both of which may act as added stressors for the scrubfowl. Using passive chew-tag and call playback surveys on five tourist-visited and five tourist-free islands, we investigated if rats and tourists negatively affect scrubfowl, and if higher rat activity is associated with tourist presence. Rat detection probability and site occupancy were significantly higher on tourist visited (89% and 99%, respectively) compared to tourist-free islands (52% and 73%). Scrubfowl were detected at significantly more stations on tourist-free (93%) than tourist visited (47%) islands and their relative abundance was higher (2.66 and 1.58 birds per station, respectively), although not statistically significantly. While rat occupancy probability likewise had a non-significant negative effect on scrubfowl numbers across islands, our results show a negative relationship between tourist presence and scrubfowl in the RISL. Our findings also suggest that rat populations may be augmented by tourist visitation in the RISL. Although this situation may not seriously affect the scrubfowl, it may be highly detrimental to populations of other threatened island landbirds.
To examine the reasons for non attendance at clinic appointments, and to identify any ways in which these rates might be reduced.
We examined the records of those patients who, having consented to a referral to a child and adolescent psychiatry service, then either failed to attend any appointments, or who ceased to attend after having attended one or more appointments, but without being discharged, over an 18-month period. The parents of these children were contacted by telephone and a semi-structured interview was conducted to ascertain the reason in each case for defaulting on the appointment.
The reasons given by the parents of the patients for missing appointments included their opinion that the referral was unnecessary (31.8%), resolution of the problem which led to the referral (22.7%), the child refusing to attend (22.7%) and problems with clinicians (9%). In the majority of cases where the parent did not consider the referral necessary, the referral had been made by the child's school (71%), with the parent reporting that they had felt pressurised into consenting to the referral.
The high levels of non-attendance at clinics have serious implications, especially if it means that those in need of services are not accessing them. The factors which we have identified in this study are chiefly patient rather than service factors, which are likely to be related to socio-economic factors.
Alcohol use and related harm is a growing problem in Ireland with far-reaching consequences for health services generally. Areas which are most affected include accident and emergency departments and psychiatric hospitals or units. The purpose of this paper is to examine the role of alcohol in psychiatric admissions to an Irish psychiatric hospital
The inpatient records for all patients admitted over a one year period were examined retrospectively. All 378 patients admitted within that time were included and their admission records were examined manually for age, gender, diagnosis of psychiatric illness, co-morbid alcohol abuse, and the role of alcohol in precipitating the admission. Data were analysed using the Statistical Package for Social Sciences, version 11.5.
21.7% of admissions had alcohol dependency syndrome and it is the primary diagnosis in 10.1%. Alcohol was a factor in the admission of 29.1% of patients. Of the 110 patients in this category, 42 did not have a primary diagnosis of alcohol dependency syndrome, i.e. 61.8% had a primary diagnosis of a psychiatric illness other than alcohol dependency syndrome.
Alcohol is a factor in a large proportion of psychiatric admissions. It has been associated with poor compliance, exacerbation of symptoms and relapse. It is important to recognise the role of alcohol in psychiatry morbidity, both as a primary diagnosis (alcohol dependency syndrome), and also where the primary diagnosis is another psychiatric illness.
The Mental Health Act 2001 was implemented in November 2006 and its introduction has heralded many important changes in the provision of mental health care in Ireland.
To examine the impact of the Act on the time and patterns of attention given to patients since its implementation, and to look at some of the difficulties encountered.
To propose amendments to the legislation, based on the experiences elicited.
This cross-sectional survey was conducted by questionnaire which we distributed along the chain of command in nursing management. They contained questions looking at attitudes to the Act and the resultant changes in nursing practise. The questionnaire also examined the levels of training with regard to the Act received by members of nursing staff. There was a space given for comments not encompassed by the questions.
317 questionnaires were returned. 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative in relation to the new legislation, with increased paper work, lack of clarity and an excessive focus on legal technicalities being the most common difficulties reported.
Nursing staff have shown mixed attitudes to the Mental Health Act 2001. However, as a majority have reported a need for increased training, this is an important need which needs to be met.
To explore clinical indications for, and results of, brain imaging in a department of general adult psychiatry.
We reviewed the 100 most recent episodes of brain imaging at the Department of General Adult Psychiatry, Mater Misericordiae University Hospital, Dublin.
Patients had a mean age of 55.30 years. The most common indications for scans were cognitive impairment (33%) and other neurological concerns (e.g. seizures) (30%). Forty-seven per cent of scans were abnormal. The most common abnormalities were ischaemia (17%) and atrophy (10%). Patients with abnormal scans were older than those with normal scans (61.90 and 48.70 years, respectively; p< 0.001).
Brain imaging contributes significantly to diagnosis in general adult psychiatry, especially for older patients.
The international literature has clearly set out the importance of having an appropriate consultation liaison psychiatry service in a general hospital. There is limited data available on the quality of psychiatric consultations in those areas which are without dedicated liaison psychiatry teams.
To examine the psychiatric work in a general hospital, and to establish a baseline regarding demographics, type of referral, and management of referrals.
To assess the psychiatric needs of the hopsital with a view to introducing improved evidence-based treatments.
All referrals from medical and surgical teams and from the accident and emergency department over a 3 month period were prospectively reviewed. As there is no dedicated liaison service, the referrals are seen by the psychiatric registrar on call. The details were entered in a register and reviewed.
160 referrals were received over the 3 months studied. 90% were from the area served by the psychiatric services based at the psychiatric unit in the hospital. The most common diagnosis was depression (27%). Alcohol was an important factor in 16% overall, and in 26% of referrals from the accident and emergency department.
In the absence of a dedicated liaison psychiatry service, the liaison work is done by the team members of the general adult and psychiatry of older age teams. As 31% of the referrals seen were not deemed urgent by the assessing psychiatrist, there may be a role for a liaison nurse in the triage of referrals to this service.
Happiness has been associated with a number of individual and societal factors, but much of the individual-to-individual variation in happiness remains unexplained. The purpose of this paper is to examine a broad range of social and psychological correlates of self-rated happiness in Europe.
We used data from the European Social Survey to determine levels of happiness in individuals (n=30,816) from seventeen European countries and to identify associations between happiness and age, gender, family relationships, satisfaction with income, employment status, community trust, satisfaction with health, satisfaction with democracy, religious belief and country of residence.
Self-rated happiness varies significantly between European countries, with individuals in Denmark reporting the highest levels of happiness and individuals in Bulgaria reporting the lowest levels. On multi-variable analysis, happiness is positively correlated with younger age, satisfaction with household income, being employed, high community trust and religious belief. Overall, these factors account for 22.5% of the individual-to-individual variation in happiness in Europe.
For the individual, this study highlights the strength of association between happiness and the individual's attitudes towards various aspects of their personal, household and societal circumstances. For social policy-makers, this study confirms the potential usefulness of civic measures to increase community trust and social capital. Further studies of the inter-relationships between individual and community-level variables would assist in further explaining the variance in happiness between individuals and countries.
To examine the referrals to a new Psycho-oncology service (one session per week) in a tertiary referral hospital in north Dublin with a Liaison Psychiatry service, and to examine the challenges and benefits of setting up a specialised psychiatry service for patients with a diagnosis of a malignancy.
Referrals were taken from any member of the multidisciplinary oncology and haematology teams, as well as from other medical or surgical teams involved in providing medical care to this population. The referrals were examined closely, along with the outcome and the follow up advised.
In the first year of the service, 28 patients were referred to the service and 26 (93%) were seen.18 (64%) were referred as consults during the course of an inpatient admission or while attending the oncology day ward; 10 (36%) were referred as out-patients. Overall 57 appointments were scheduled with an 86% attendance rate. Over the year, the number of referrals gradually increased with time as the service became more widely known. The most common psychiatric diagnoses were depression and adjustment disorder, at 21% each. 54% of patients also had input from the Palliative Medicine service.
It became evident from the referrals that there are substantial psychiatric needs in this population, and this need had been previously unmet. As we established a specialist service, the service uptake was initially slow, but as the service became more widely known in the hospital the number of referrals increased.
Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/ substance abuse and migrant status leading to frequent co-morbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness.
A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data.
Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects; others such as rifampicin may reduce the effective doses of anti-psychotics by their enzyme-inducing actions. Mental illness and substance abuse may also affect treatment concordance, with consequences for public health.
Due to the common co-morbidity of mental illness and tuberculosis, it is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.
To examine the predictors of suicidal ideation and self-harm in patients diagnosed with a depressive episode or an adjustment disorder, and to examine any difference in these predictors between the two diagnostic categories.
Patients referred to the liaison psychiatry services at two Dublin hospitals and diagnosed with either a depressive episode or an adjustment disorder were recruited to this study. They were interviewed at time of diagnosis, and again after six months, with a number of validated instruments to examine levels of suicidality or self-harm and their relationship to depressive symptoms, life events, social functioning and personality factors.
300 patients were recruited to the study, 154 of whom had a diagnosis of an adjustment disorder and the remainder diagnosed with a depressive episode. On univariate analysis there was no significant difference in the rates of suicidal ideation between the diagnoses of depressive episode and adjustment disorder. On logistic regression there were no significant predictors of suicidal ideation in adjustment disorder. A single marital status and low levels of social support were more predictive of suicidality in the subgroup with a diagnosis of depression.
There has been little prior research into the predictors of suicidal behaviour in patients with diagnoses of depression and adjustment disorders. Our finding that social support and marital status are protective against suicidality in this population is in keeping with the literature. The absence of any significant contribution of the severity of depressive symptoms to suicidality was unexpected.
Genome-wide association study (GWAS) suggested that the genes coding for human leukocyte antigens (HLA) were associated with schizophrenia, of which the DRB1*0301, DQA1*0501 and DQB1*0201 variants were strongly associated with a low risk of the illness although the disease-causing variant remains unknown. Haplotype analysis suggested that the haplotypes contraining a HLA-DRB1*13 variant were excessively transmitted by parents to their offspring with schizophrenia in a Chinese population. Accordingly, this study was designed to genotype three HLA-DRB1*13 variants using six HLA-tagging SNPs in a British population to confirm which one of these 3 variants could contribute to the etiology of schizophrenia. Because of the failure of genotyping rs6905141, the DRB1*1302 association was not analysed. While the DRB1*1301 and DRB1*1303 variants were not associated with the disease, the minor allele of rs424232 was used to construct the haplotype tagging to the DRB1*1303 variant showed a strong association with a low risk of schizophrenia (p = 0.002), suggesting that the major allele of rs424232 may be in linkage disequilibrium with a disease-underlying vatriant. In conclusion, the HLA-DRB1*13 variants are unlikely to be involved in the development of schizophrenia but there may be a variant nearby which is involved.
In this study we aimed to examine the characteristics of patients diagnosed with depressive episode or adjustment disorder, and to explore the interplay between these diagnoses and personality disorder/traits.
Patients referred to the liaison psychiatry services at three Dublin hospitals and diagnosed with either a depressive episode or an adjustment disorder were recruited to this study. They were interviewed at time of diagnosis and again after six months using validated instruments, including SCAN (Schedule for Clinical Diagnosis in Neuropsychiatry - a semi-structured diagnostic interview schedule) and possible personality disorder as measured by SAPAS (Standardised Assessment of Personality - Abbreviated Scale).
370 patients were recruited to the study, 185 of whom had a diagnosis of an adjustment disorder; the remainder were diagnosed with a depressive episode according to ICD-10 criteria. SCAN (Schedule for Clinical Diagnosis in Neuropsychiatry - a semi-structured diagnostic interview schedule) was not useful in distinguishing between these two diagnoses. Patients with a SAPAS score above 3 (cut-off for likely personality disorder) and a diagnosis of adjustment disorder had an increased risk of suicidal behaviour (p = 0.001). When both diagnostic groups were analysed together, patients with a SAPAS score above 3 had an increased risk of suicidal behaviour (p = 0.007).
There has been little prior research into personality disorder and its association with adjustment disorder. Personality traits are associated with a diagnosis of depression rather than adjustment disorder, but have a stronger association with suicidal behaviour in patients with a diagnosis of adjustment disorder.
Posttraumatic stress disorder and substance use disorder is an important comorbidity in terms of its prevalence, clinical impact, and treatment challenges. To date, interventions for this comorbidity have been solely professionally led.
In this pilot study, we sought to evaluate the impact of a peer-led model, using Seeking Safety (SS; Najavits, 2002), which is the most evidence-based intervention thus far for the comorbidity. We adapted it for peer-led use to help make it accessible and safe for this modality.
Eighteen women in residential substance abuse treatment participated. The 25 SS topics were conducted twice weekly. They were assessed at baseline and end of treatment, with some measures also collected at monthly interims.
Results showed decreases in trauma-related symptoms (Trauma Symptom Checklist-40 total scale and all subscales, i.e., dissociation, sexual problems, depression, sleep problems, anxiety, and sexual abuse); self-compassion (the Self-Compassion Scale subscales self-judgment, isolation, and overidentified); the Brief Symptom Inventory (total and all nine subscales); and a measure of use of SS coping skills (total score). Also, ratings of fidelity to SS was very high (on the SS Adherence Scale), as was satisfaction with SS.
Limitations of the study and areas for future research development are discussed.